Expanding Size, Variety of Infection Prevention Team Pays Off

To meet unprecedented expansion needs, the Children’s Hospital of Philadelphia (CHOP) revamped its infection prevention team by adding more staff and making sure that the staff had a diversified background. This resulted in a 23% decrease in healthcare-associated infections (HAIs) between 2014 and 2018, according to a study in the American Journal of Infection Control. This reduction in HAIs occurred even as patient days, central line days, ventilator days, and device utilization increased each year. Investigators with CHOP noted that HAIs account for about 72,000 deaths each year in the United States, roughly 1 in 31 inpatients.

CHOP investigators also note that the role of the infection preventionist (IP) has grown in recent years, thanks in part to state and federal mandates concerning the reporting of healthcare-acquired infections (HAIs). This focus on HAI surveillance diverts the IP’s attention away from other infection control duties.

“In addition, IPs have a more prominent role as frontline responders to public health emergencies related to both emerging and re-emerging infectious diseases, such as pandemic H1N1 influenza, Ebola virus disease, outbreaks of vaccine-preventable diseases (eg, measles) and rising antimicrobial resistance,” the study states. “Furthermore, device-related outbreaks, such as those associated with contaminated heater-cooler units and duodenoscopes, require prompt investigation and resource-intensive responses. The latter have underscored the need for enhanced infection prevention and control (IPC) oversight and increased regulatory scrutiny of high-level disinfection and sterilization programs.”

CHOP created a 3-tier career ladder for its infection preventionists and drew equally from nursing, public health, and laboratory scientist backgrounds. Using a framework developed by the Association for Professionals in Infection Prevention and Epidemiology (APIC) that recognizes novice, proficient and expert IPs, the CHOP career ladder consists of Infection Preventionist I, Infection Preventionist II, and Senior Infection Preventionist. The IP staff grew from 4 to 9, and added the additional support roles of hand hygiene program manager, infection prevention associate and a clinical practice analyst. These changes expanded the education and consultative range of the department, as measured by a 33% increase in environmental rounding and a 7-fold increase in performance of isolation audits.

“The core strategies we chose to implement were to increase staffing due to organization growth, create career ladders to recruit and retain talented IPs and to add cost-efficient supporting team roles,” the study states. “These strategies will allow our team to keep pace with the rapid expansion of our organization and growing complexity of the field, while continuing to promote safer patient outcomes.”

Investigators with CHOP developed an algorithm for 5 key HAIs: central line associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator associated pneumonia (VAP), and healthcare-associated viral infections. There was a statistically significant reduction in rates of harm across the 5 key HAIs, the study says.

The study states that CHOP’s infection control department takes the novel approach of providing supporting roles in infection prevention, which can serve as “entry level positions for future IPs while providing cost-effective support for the needs of the program. Diversifying roles and creating support staff benefits the team by increasing the productivity of the department and providing a deeper bench so that IPs can focus on broader activities requiring specific subject matter expertise. In addition, this staffing structure engages employees in career development in alignment with the APIC competencies to support retention and increased employee satisfaction….”